Comparison of different ways of repairing fresh femoral neck fracture in the elderly

doi:10.3969/j.issn.2095-4344.2015.09.014

Abstract

Abstract:

BACKGROUND: The internal fixation and total hip replacement are two main methods for the treatment of fresh femoral neck fracture in elderly patients. But, the surgical indications and the pros and cons still have a lot of controversies.
OBJECTIVE: To compare the effects of closed reduction and internal fixation, open reduction and internal fixation + joint capsule decompression, and total hip replacement in the treatment of fresh femoral neck fracture in elderly patients.
METHODS: A retrospective study of clinical data among 213 patients with femoral neck fractures was performed. Depending on the type of fracture, the involved patients were divided into non-displacement (A group) and displacement (group B); according to operation methods, the A group was further assigned into closed reduction and internal fixation (A1), open reduction and internal fixation + joint capsule decompression (A2), and total hip replacement (A3); in the same way, the B group was assigned into B1, B2, B3. Patients were followed up for 1-3 years, the operative time, intraoperative blood loss, postoperative ambulation time, postoperative weight-bearing time, postoperative complications, and postoperative Harris scores were compared.
RESULTS AND CONCLUSION: Harris score in A2 group was significantly better than the A1 and A3 groups, Harris score in B2 group was also significantly better than the B1 and B3 groups. The incidence of avascular necrosis in B2 group was significantly lower than that in B1 group. The operative time and intraoperative blood loss in the A1 and A2 groups were significantly better than the A3 group, but postoperative ambulation time and postoperative weight-bearing time were significantly less. For the vast majority of the elderly patients with fresh femoral neck fracture, the preferred treatment is anatomical repositioning using reliable internal fixation, open reduction and hollow tension screw internal fixation + joint capsule decompression is pronounced, and the treatment is suggested to be completed within 6-12 hours after injury. Total hip replacement should be considerably selected based on the specific circumstances of patients, the surgeon experience, and comprehensive analysis of surgical indications.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: Femoral Fractures, Arthroplasty, Replacement, Hip, Internal Fixators, Follow-Up Studies

CLC Number:

R318

Li Gui-chun, Wang Wen-ji. Comparison of different ways of repairing fresh femoral neck fracture in the elderly[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(9): 1393-1399.

Figures/Tables 2

References

[1] 陈孝平,汪建平.外科学[M].北京:人民卫生出版社, 2013: 676-680.
[2] 杨宗酉,邢欣,张奇.股骨颈骨折治疗关键技术研究进展[J].中华创作杂志,2014,30(2):274.
[3] Frihagen F, Nordsletten L, Madsen JE. Hemiarthroplasty or internal fixation for Intracapsular displaced femoral neck fractures: randomised controlled trial. BMJ. 2007; 335(7632): 1251-1254.
[4] 王满宜,危杰.股骨颈骨折临床研究的若干问题新概念[J].中华创伤骨科杂志,2003,5(1):5.
[5] 贺良,王满宜.安全治疗高龄骨折[J].中华创伤骨科杂志,2004, 6(9):992-994.
[6] Schmidt AH, Leighton R, Parvial J, et al. Optimal arthroplasty for femoral neck fractures: is total hip arthoplasty the answer. J Orthop Trauma. 2009;23(6):428-433．
[7] Huang J, Jiang W, Xu R, et al. Primary gastric non-Hodgkin’s lymphoma in Chinese patients: clinical characteristics and prognostic factors. BMC Cancer. 2010; 1(1):358.
[8] Ismail AA, Pye SR, Cockefill WC, et al. Incidence of limb fracture across Europe: results from the European Prospective Osteoporosis Study(EPOS). Osteoporos Int. 2002;13(7):565-571.
[9] 王裕民,胡永成,李欣,等.老年伴有并存症的股骨颈骨折髋关节置换疗效分析[J].中国矫形外科杂志,2005,16(11): 1215-1218.
[10] 冼敬锋.全髋关节置换术与骨折内固定术治疗中老年股骨颈骨折的疗效分析[J].重庆医学,2013,42(13):1528-1529.
[11] 晓牧.全髋关节置换术和骨折内固定术治疗中老年人股骨颈骨折的疗效[J].中国老年学杂志,2014,34(7):1976-1977.
[12] Russell TA. Techniques in Orthopaedic Trauma. American Academy of Orthopaedic Surgeons, 2007.
[13] 危杰,王满宜.股骨颈骨折的内固定手术治疗[J].中华创伤骨科杂志,2003,5(1):64.
[14] 孙彦豹,王静,金宝成,等. 股骨头干三维互动闭合复位技术在股骨颈骨折治疗中的应用[J].中国骨与关节损伤杂志,2013, 28(10):908-910.
[15] Yu YX, Ma JZ, Zhu LB, et al. Failure of internal fixation on displaced femoral neck fractures in adults under fifty-fiveyears old. Zhongguo Gu Shang.2012;25(7): 542-545.
[16] 夏胜利,王秀会,王子平,等.股骨颈骨折空心螺钉内固定术中三种不同导针定位方法的疗效比较[J].中华创伤骨科杂志,2014, 16(5):444-447.
[17] 杨召,马信龙,张园,等.股骨颈骨折后股骨头坏死的原因分析[J].医学生物力学,2009,5(1):99.
[18] 成人股骨头坏死诊断标准专家共识(2012版) [J].中华骨科杂志,2012,32(6):606-608
[19] 刘志雄.骨科常用诊断分类方法和功能结果评定标准[M].北京: 科学技术出社,2005:268-270.
[20] 田敏,崔存宝,王东辰,等.老年股骨颈骨折人工髋关节置换67例临床报告[J].中国矫形外科杂志,2014,22(14):1325-1327.
[21] Ganzer D, Forke L, Irlenbusch U.Two-year follow-up of revision total hip arthroplasty using a ceramic revision head with a retained well-fixed femoral component: a case series. J Med Case Rep. 2014;8(1):434.
[22] Parker MJ, Gurnsamy K. Internal fixation versus arthroplasty forntraeapsular proximal femoral fractures in adults. Cochrane Database Syst Rev. 2006;(4): CD001708.
[23] Parker MJ, Gurnsamy KS, Azegami S. Arthroplasties (with and without bone cement) for proximal femoral fractures in aduhs. Cochrane Database Syst Rev. 2010;(6):CD001706.
[24] 徐明轩,黄野.老年股骨颈骨折的治疗进展[J].医学综述,2014, 20(14):2591.
[25] 白煜.老年股骨颈骨折两种手术治疗对比分析[D].大连医科大学,2013.
[26] 管伟荣.老年新鲜无移位型股骨颈骨折治疗的临床研究进展[J].当代医学,2014,20(26):362.
[27] Gao H, Liu Z, Xing D, et al. Which is the best alternative for displaced femoral neck fractures in the elderly? A meta-analysis. Clin Orthop Relat Res. 2012;470(6):1782.
[28] 朱蓝玉,秦彦国,王艳华,等.老年患者全髋关节置换观念[J].中国老年学杂志,2013,33(8):1945-1946.
[29] Shan L, Shao B, Graham D, et al. Total hip replacement: a systematic review and meta-analysis on mid-term quality of life. Osteoarthritis Cartilage. 2014;22(3):389-406.
[30] 郭学峰,王裕民.老年股骨颈骨折的治疗进展[J].中国矫形外科杂志,2014,22(16):1488-1491.
[31] 钱学峰,徐能.经皮空心螺钉内固定治疗股骨颈骨折[J].中华创伤骨科杂志,2013,15(5):453-454.
[32] 王清富,石峰,陈庄洪,等.影响空心加压螺钉治疗股骨颈骨折骨愈合的因素分析[J].中国中医骨伤科杂志,2013,21(8):34-36.
[33] 卢庆弘.影响空心加压螺钉治疗股骨颈骨折骨愈合的因素分析[J].中国骨伤,2012,28(12):1040-1044.
[34] Wazir NN, Mukundala VV, Choon DS. Early results of prosthetic hip replacement for femoral neck fracture in active elderlpatients.J Orthop Surg. 2006;14(1):43-46.
[35] 骆文勇,黄忠毅,傅军华,等.三种手术方法治疗老年股骨颈骨折126例疗效对比[J].中国骨与关节损伤杂志,2010,25(8): 729-730.
[36] 杨洋,林向进.877例髋部骨折患者发病情况及其流行病学特征分析[J].中华流行病学杂志,2014,35(4):446-448.
[37] 危杰,周力,王满宜.股骨颈骨折术后股骨头缺血坏死的发生及转归[J].中华创伤骨科杂志, 2005,01(25):1-5.
[38] 赵奇,刘世清,明江华.加压空心螺纹钉置入治疗成人股骨颈骨折:内固定失效分析[J].中国组织工程研究,2014,18(44): 7138-7143.
[39] 张庆天.Garden复位指数对空心钉治疗股骨颈骨折预后的影响[J].浙江临床医学,2013,15(1):76-77.
[40] Triantaphillopoulos PG, Panagiotopoulos EC, Mousafiris C, et al. Long-term results in surgically treated acetabular fractures through the posterior approaches. J Trauma. 2007;62(2):378-382.
[41] 罗正亮,尚希福,胡飞,等.全髋关节置换术治疗创伤性股骨头缺血性坏死的疗效分析[J].中华医学杂志,2014,(23):1773- 1776.
[42] 江辉,闫韵飞,赵建宁.3种手术方式治疗中老年股骨颈骨折疗效对比分析[J]. 医学研究生学报,2012,25(7):746-748.